Category: Caregiving

NewsPsychology (Mar. 25, 2011) — Stroke patients who received electrical brain stimulation coupled with swallowing exercises showed greater improvement in swallowing ability than patients who did not receive this stimulation, according to a pilot study reported in Stroke: Journal of the American Heart Association.

Difficulty swallowing, known as dysphagia, is a common and serious stroke complication. It can lead to aspiration, when food or foreign matter accidentally enters the lungs causing pneumonia. Aspiration and aspiration pneumonia are common complications after stroke and can be deadly.

The non-invasive brain stimulation used in this study (Transcranial Direct Current Stimulation, or tDCS) uses a weak electrical current. It is transmitted via electrodes placed on the scalp, to increase activity in targeted areas of the brain. Researchers noted:

• Patients who received brain stimulation increased their ability to swallow by more than 2.5 points on a seven-point swallowing scale, compared to slightly more than one point among those who did not receive the treatment. This was statistically significant, so it was not likely due to chance.
• Overall, swallowing ability improved by at least two points in 86 percent of patients receiving stimulation, and in 43 percent of those who did not. While these percentages showed a trend toward improvement, they did not reach statistical significance, likely due to the small study size.

“Further studies are warranted to refine this promising intervention by exploring effects of stimulation parameters, frequency of stimulation, and timing of the intervention in improving swallowing functions in dysphagic-stroke patients,” researchers noted.

The study comprised 14 patients recruited from the inpatient stroke center at Beth Israel Deaconess Medical Center in Boston. All patients had suffered an ischemic stroke within the previous one to seven days. Participants were randomized so that some received tDCS to the brain regions that control swallowing while others received “sham stimulation.” Those receiving sham stimulation were prepped as if they are going to receive tDCS but did not.

Authors are: Sandeep Kumar, M.D.; Cynthia W. Wagner, M.S., CCC-SLP; Colleen Frayne, M.S., CCC-SLP; Lin Zhu, B.S.; Magdy Selim, M.D., Ph.D.; Wuwei Feng, M.D., M.S.; and Gottfried Schlaug, M.D., Ph.D. The National Institutes of Health and the Center for Integration of Medicine and Innovative Technology funded the study.

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The above story is reprinted (with editorial adaptations by newsPsychology staff) from materials provided by American Heart Association.

Journal Reference:

1. Sandeep Kumar, Cynthia W. Wagner, Colleen Frayne, Lin Zhu, Magdy Selim, Wuwei Feng, Gottfried Schlaug. Noninvasive Brain Stimulation May Improve Stroke-Related Dysphagia: A Pilot Study. Stroke, 2011; DOI: 10.1161/STROKEAHA.110.602128

Disclaimer: This article is not intended to provide medical advice, diagnosis or treatment. Views expressed here do not necessarily reflect those of NewsPsychology ( or its staff.

— Patients who have suffered a "mini stroke" are at twice the risk of heart attack than the general population, according to research reported in Stroke: Journal of the American Heart Association.

These mini-strokes, called transient-ischemic attacks, or TIAs, occur when a blood clot temporarily blocks a blood vessel to the brain. Although the symptoms are similar to a stroke, a TIA is shorter ─ usually lasting only minutes or a few hours ─ and does not cause long-term disability. A TIA, also called a "warning stroke," signals a high risk of a subsequent, larger stroke.

In this study, the risk of heart attack among TIA patients was about 1 percent per year, double that of people who had never had a TIA. This increased risk persisted for years and was highest among patients under age 60, who were 15 times more likely than non-TIA patients to have a heart attack.

"Physicians and other healthcare providers should be mindful of the increased risk for heart attack after TIA, just as they are about the increased occurrence of stroke," said Robert D. Brown Jr., M.D., M.P.H., principal investigator and chair of the neurology department at the Mayo Clinic in Rochester, Minn. "In the same way that we evaluate the patient to determine the cause of TIA and implement strategies to reduce the occurrence of stroke after a TIA, we should step back and consider whether a stress test or some other screening study for coronary-artery disease should also be performed after a TIA, in an attempt to lessen the occurrence of heart attack."

In the study, the average length of time between a first TIA and a heart attack was five years. Researchers also found that TIA patients who later had a heart attack were three times more likely than those who did not have a heart attack to die during study follow-up.

Factors that independently increased the risk of heart attack after TIA included:

• male gender;
• older age; and
• use of cholesterol-lowering medications (although patients using these drugs may have had more severe heart disease initially).

The study included 456 patients (average age 72, 43 percent men) diagnosed with a TIA between 1985 and 1994. Nearly two-thirds had high blood pressure, more than half smoked, and three-fourths were being treated with medication, such as aspirin, to prevent blood clots. Average follow-up was 10 years.

Investigators used a medical-records database (Rochester Epidemiology Project) to retrospectively identify TIA patients in Rochester, Minn. They then cross-referenced this information with data on heart attacks occurring within this patient group through 2006.

Most heart attacks are caused by coronary-artery disease, which occurs when a blood clot blocks blood and oxygen flow in a blood vessel leading to the heart. Although coronary-artery disease is the primary cause of death among TIA patients, according to the study, limited data exist on the incidence of heart attack after TIA.

"In fact, coronary-artery disease is an even greater cause of death after transient-ischemic attack than stroke is, surprising as that may be," Brown said. "We should use the TIA event not only to provide a warning sign that patients are at heightened risk of stroke, but are also at increased risk of heart attack, an event that will increase their risk of death after the TIA."

Co-authors are Joseph D. Burns, M.D.; Alejandro A. Rabinstein, M.D.; Veronique L. Roger, M.D., M.P.H.; Latha G. Stead, M.D.; Teresa J. H. Christianson, B.S.; and Jill M. Killian, B.S. Author disclosures are on the manuscript.

The Mayo Clinic funded the study. TIA and stroke warning signs are sudden:

• Numbness or weakness of the face, arm or leg, often on only one side of the body
• Confusion and trouble speaking or understanding others
• Difficulty seeing
• Trouble walking, feelings of dizziness and loss of balance or coordination
• Severe headache of unknown cause

The presence of any of these signs warrants a call to 9-1-1 for immediate medical attention.

Journal Reference:

1. Joseph D. Burns, Alejandro A. Rabinstein, Veronique L. Roger, Latha G. Stead, Teresa J.H. Christianson, Jill M. Killian, Robert D. Brown Jr. Incidence and Predictors of Myocardial Infarction After Transient Ischemic Attack: A Population-Based Study. Stroke, 2011; DOI: 10.1161/STROKEAHA.110.593723

— There are 50 million family members providing care to older adults in the United States, according to the MetLife Foundation and national caregiving associations. When older adults are hospitalized and discharged, their families face numerous choices about where they will go and how they will receive care. A University of Missouri nursing expert says the complexity of this process will intensify with increasing demands for health care and workforce shortages.

"Coordination among families, patients and health care providers is essential to providing effective care for the aging population in the next few years," said Lori Popejoy, assistant professor in the MU Sinclair School of Nursing. "Stress, fear and lack of understanding often complicate the decision-making process for families and patients. Open communication is needed to support end-of-life care and decision making."

Hospital visits and discharge processes are often complicated; family members have to communicate with each other and health care team members (HCTMs), which include physicians, nurses and hospital staff, about treatments and make decisions with limited resources. Popejoy identified common concerns about the process: going home, advocating for independence, making decisions and changing plans.

"A new approach to the hospital discharge process should further consider the rights of patients and families — to be fully and accurately informed of older adults' conditions and realistic care options, including home care, personal care and nursing homes," Popejoy said.

Popejoy says decision making should be an interactive and incremental process that occurs among patients, families and HCTMs. A HCTM can be designated to communicate information among care providers, patients and their families. In previous research, Popejoy found that families and patients who worked with a nurse communicator reported less stress and better overall care.

Journal Reference:

1. L. L. Popejoy. Complexity of Family Caregiving and Discharge Planning. Journal of Family Nursing, 2011; 17 (1): 61 DOI: 10.1177/1074840710394855

 — Individuals with poorer health or psychological issues may be prone to developing chronic widespread pain following a traumatic event. This new research, published in Arthritis Care & Research, a peer-reviewed journal of the American College of Rheumatology (ACR), found that the onset of chronic pain was more often reported following a traffic accident than from other physically traumatic triggers.

The ACR defines chronic widespread pain as the presence of pain above and below the waist, or on both the left and right sides of the body, for three months or longer. Prior studies have reported chronic widespread pain prevalence rates between 11% and 13% in Germany, Sweden, the U.K. and the U.S. Medical literature suggests that this type of pain increases with age, is more common in women than men, and is a primary characteristic of fibromyalgia — one of the most common reasons for rheumatology consultations worldwide.

"We believe there are persons — defined by prior physical and psychological health — who in the event of a traumatic trigger are vulnerable to developing chronic widespread pain," explained Gareth Jones, PhD, of the University of Aberdeen School of Medicine and Dentistry, U.K., and lead author of the current study. "Under this hypothesis, the precise nature of the traumatic event may even be immaterial."

To examine the relationship between different physically traumatic events and the onset of chronic widespread pain, researchers followed 2069 participants from the Epidemiology of Functional Disorders (EPIFUND) study. Participants in the EPIFUND study, a population-based prospective cohort, provided data on musculoskeletal pain and associated psychological distress at three time points over a four-year period. Patients were also asked about their recent experience with six physically traumatic events — traffic accident, workplace injury, surgery, fracture, hospitalization and childbirth.

Of those who participated in the study through follow-up, 241 (12%) reported new onset of chronic widespread pain, with more than one-third of these subjects more likely to report at least one traumatic event during the study period than other individuals. After researchers adjusted for age, sex, general practice and baseline pain status, those who reported a traffic accident experienced an 84% increase in the likelihood of new onset chronic widespread pain. No association was observed with hospitalization, surgery or in women who gave birth. "Further research should focus on the unique aspects of an auto accident and the individual's reaction to this particular trauma that causes the increased risk of chronic widespread pain onset," concluded Dr. Jones.

Journal Reference:

1. Gareth T Jones, Barbara I Nicholl, John McBeth, Kelly A Davies, Richard K Morriss, Chris Dickens, Gary J Macfarlane. Road traffic accidents, but not other physically traumatic events, predict the onset of chronic widespread pain: Results from the EpiFunD study. Arthritis Care & Research, 2011; DOI: 10.1002/acr.20417

 Online messaging can deliver organized follow-up care for depression effectively and efficiently, according to a randomized controlled trial of 208 Group Health patients that the Journal of General Internal Medicine e-published in advance of print.

After five months, compared to the half of the patients randomly assigned to receive usual care, the half who had three online care management contacts with a trained psychiatric nurse were significantly more likely to feel less depressed, take their antidepressant medication as prescribed, and be "very satisfied" with their treatment for depression. The patients in the trial were starting antidepressant medication that their primary care providers prescribed.

"While more Americans are taking antidepressants, the quality of care for depression remains among the lowest scores on the U.S. health care report card," said Gregory E. Simon, MD, MPH, a Group Health psychiatrist and Group Health Research Institute senior investigator. "Especially in primary care, where most treatment for depression starts, not enough patients receive follow-up contact or take their antidepressant medication as prescribed."

In previous studies, Dr. Simon and his colleagues have successfully delivered organized care for depression using telephone calls. Organized depression care means systematically reaching out to patients, assessing their depression and whether they are taking their antidepressant medication as prescribed, and following guidelines for evidence-based care. One such guideline is suggesting that the primary care provider change the dose — or add or switch to another medication — if depression or side effects bother a patient after a standard trial period. The bottom line: persistently tailoring treatment to boost each individual's response.

Why try pursuing these same goals using online messaging instead of phone calls?

"Recently, for each phone contact with a patient, we've wasted a half hour on playing 'phone tag,'" Dr. Simon said. Unlike phone calls, online messages require no simultaneous live contact, so they may boost the convenience and affordability of follow-up care. He and his colleagues have found that secure, asynchronous messages within Group Health's existing electronic medical record can improve care of chronic conditions — and that patients being treated for depression are particularly likely to use online communication with their health care providers.

"We worried that patients might need live voice contact in real time to be understood and feel supported," Dr. Simon said. "But this online care management helped these patients, even though they never met the trained psychiatric nurse in person or talked with her on the phone. And because she spent only one hour per patient to deliver this intervention, it promises to make high-quality depression care more affordable."

The National Institute of Mental Health funded the trial. Dr. Simon's coauthors were James D. Ralston, MD, MPH; James Savarino, PhD; Chester Pabiniak, MS; Christine Wentzel, RN; and Belinda H. Operskalski, MPH, of Group Health.

Journal Reference:

1. Simon GE, Ralston JD, Savarino J, Pabiniak C, Wentzel C, Operskalski BH. Randomized Trial of Depression Follow-Up Care by Online Messaging. J Gen Intern Med, March 8, 2011

Stroke patients who are not successfully treated for depression are at higher risk of losing some of their capability to function normally, according to a study in the March 15, 2011 issue of the journal Neurology.

Although as many as a third of those who experience a stroke develop depression, a new study by researchers from the Regenstrief Institute, the schools of health and rehabilitation sciences and of medicine at Indiana University-Purdue University Indianapolis and the Richard L. Roudebush VA Medical Center is the first to look whether managing post-stroke depression improves physical functioning.

They researchers report that individuals who remain depressed three months after a stroke are more likely to have decreased functional capabilities than those whose depression was successfully treated. Functional capabilities include getting dressed, feeding oneself, and accomplishing other tasks. These capabilities increased significantly in those individuals who were treated for depression.

Post-stroke depression appears to be linked to chemical changes in the brain, clinical evidence indicates.

"The relationship between post-stroke depression and recovery of function after a stroke has not been well understood. Previous researchers have looked at both depression and function after stroke but they did not investigate whether identifying and managing depression improved ability to accomplish tasks of daily living and other function related issues," said study first author Arlene A. Schmid, Ph.D., a Regenstrief Institute investigator, an assistant professor of occupational therapy at the IU School of Health and Rehabilitation Sciences and a VA Center of Excellence on Implementing Evidence Based Practice investigator.

The researchers in the new study report that successful depression management led to better functionality that might enable the individual to return to work or more thoroughly enjoy leisure functions while decreasing the caregiver burden.

"Restoring lost function after stroke is the number one reason individuals visit occupational therapists," said Dr. Schmid. "Since treating depression helps improve function, occupational therapists should screen for post-stroke depression and, in conjunction with other members of the patient's health care team, help manage depression."

In the Neurology study, whether an individual was depressed or not was determined through use of the Health Questionnaire-9 (PHQ-9), a widely used and easy to administer depression screening tool. The PHQ-9 was originally developed by Kurt Kroenke, M.D., a Regenstrief Institute investigator and IU School of Medicine professor of medicine. Dr. Kroenke, who is a co-author of the new study, has described the PhQ-9 as "a sort of a blood pressure cuff for depression."

According to Dr. Schmid, since occupational therapists are trained in mental health issues and see patients frequently, occupational therapists could use the PHQ-9 to screen for depression after stroke and alert a post-stroke patient's physician to the individual's mental status.

In addition to improving functionality, management of depression would lower health care costs associated with functional impairment and other post-stroke treatment issues.

"Post-stroke depression often impacts quality of life after stroke more than even functional impairments. Since it is treatable with common medications, cognitive behavioral therapy and exercise, it is important to recognize it so patients can be treated. This study is one of the first to show not just the link between depression and worse function post-stroke, but that successfully treating depression symptoms actually improves post-stroke outcomes," said Linda S. Williams, M.D., a Regenstrief Institute investigator, associate professor of neurology at the IU School of Medicine, and a VA Center of Excellence on Implementing Evidence Based Practice investigator.

The study was funded by the National Institute of Neurological Disorders and Stroke.

Journal Reference:

1. A. A. Schmid, K. Kroenke, H. C. Hendrie, T. Bakas, J. M. Sutherland, L. S. Williams. Poststroke depression and treatment effects on functional outcomes. Neurology, 2011; 76 (11): 1000 DOI: 10.1212/WNL.0b013e318210435e

— Patients with a disease known as retinal vein occlusion (RVO) have a significantly higher incidence of stroke when compared with persons who do not have RVO, according to a report in the March issue of Archives of Ophthalmology, one of the JAMA/Archives journals.

"Retinal vein occlusion (RVO) is a retinal vascular disease in which a retinal vein is compressed by an adjacent retinal artery, resulting in blood flow turbulence, thrombus formation, and retinal ischemia," the authors write as background information in the article. "Although RVO is a significant cause of severe visual impairment in adults, it can occur at any age." Older age, diabetes, hypertension and vascular disease are among the risk factors for RVO.

Winifred Werther, Ph.D., then of Genentech Inc., South San Francisco, Calif., now of Vertex Pharmaceuticals, Cambridge, Mass., and colleagues conducted a retrospective cohort study to compare the incidence rates of myocardial infarction (MI, heart attack) and cerebrovascular accident (CVA, stroke) in hospitalized patients with and without retinal vein occlusion. The researchers used a U.S. population-based health care claims database to identify patients with RVO and control patients, matched for age and sex.

Among 4,500 patients with RVO and 13,500 control patients, the researchers found that patients with RVO had an almost two-fold higher incidence of stroke than the age- and sex-matched controls.

"Event rates for CVA were 1.16 and 0.52 per 100 person-years for RVO and controls, respectively," the authors report.

In contrast, event rates for heart attack were similar in the patients with RVO and the control patients.

"Although men and patients younger than 65 years with RVO had a 1.6- and 1.9-fold higher risk of MI, respectively, compared with controls, there were no statistically significant differences in MI rates between patients with RVO and controls when they were stratified by sex or age," the authors write.

They conclude that "these data suggest that physicians and patients should be aware of the possible increased risk of CVA but not of MI in patients with RVO."

Journal Reference:

1. Winifred Werther; Laura Chu; Nancy Holekamp; Diana V. Do; Roman G. Rubio. Myocardial Infarction and Cerebrovascular Accident in Patients With Retinal Vein Occlusion. Arch Ophthalmol, 2011; 129 (3): 326-331 DOI: 10.1001/archophthalmol.2011.2

Researchers from Boston University School of Medicine (BUSM) have found that for the majority of patients with opioid addiction, collaborative care with nurse care managers is a successful method of service delivery while effectively utilizing the time of physicians prescribing buprenorphine.

The findings, which appear in the March 14 issue of the Archives of Internal Medicine, serve as a model of service delivery for facilitating access and improving outcomes in patients with opioid addiction.

Opioid addiction is a chronic, relapsing brain disease that affects millions of Americans and places a tremendous burden on the healthcare system. Recent studies have revealed alarming increases in opioid addiction and overdoses, particularly with regard to prescription opioids. Less than 25 percent of individuals addicted to opioids receive addiction treatment.

In 2002, US physicians gained the opportunity to treat opioid-addicted patients with buprenorphine in primary care settings, commonly referred to as office-based opioid treatment (OBOT). Although OBOT has been shown to be effective in primary care settings, it remains underutilized in traditional care models mainly due to the lack of adequate clinical support given the additional needs for patient monitoring.

From 2003 to 2008, 408 patients with opioid addiction were treated with buprenorphine utilizing collaborative care between nurse care managers and generalist physicians. At 12 months, 51 percent of patients (196/382) underwent successful treatment. Of patients remaining in treatment at three, six, nine and 12 months, 93 percent were no longer using illicit opioids or cocaine based on urine drug tests.

"These outcomes were achieved with a model that facilitated physician involvement," said lead author Daniel P. Alford, MD, MPH, FACP, FASAM, an associate professor of medicine at BUSM.

"Our study shows that in this particular setting, collaboration with nurse care managers allowed academic generalist physicians with research, administrative and clinical responsibilities to effectively and safely treat a large number of patients, many of whom had complex psychosocial needs," he added.

According to the researchers this study adds to the growing body of evidence that office-based treatment of opioid addiction is feasible in primary care settings.

Funding for this study was provided by the Massachusetts Department of Public Health.

Journal Reference:

1. Daniel P. Alford; Colleen T. LaBelle; Natalie Kretsch; Alexis Bergeron; Michael Winter; Michael Botticelli; Jeffrey H. Samet. Collaborative Care of Opioid-Addicted Patients in Primary Care Using Buprenorphine: Five-Year Experience. Arch Intern Med, 2011; 171 (5): 425-431 DOI: 10.1001/archinternmed.2010.541

People who have a stroke are more likely to be dependent if they are depressed, older or have other medical problems, according to a study published in the March 15, 2011, print issue of Neurology®, the medical journal of the American Academy of Neurology.

"Post-stroke depression is a common problem. About 795,000 people in the United States have a stroke each year and one third of survivors develop depression as a result," said study author Arlene Schmid, PhD, OTR, with the Richard L. Roudebush Veterans Affairs Medical Center and Indiana University in Indianapolis. "We wanted to see whether depression and other factors affected function and dependence after a stroke."

For the study, researchers gathered information about 367 ischemic stroke survivors with an average age of 62 with no severe language or thinking skill impairments. Of those, 174 were diagnosed with post-stroke depression one month after the stroke.

The participant's level of independence was rated using a zero to five scale, with five being the most severely disabled and dependent. Three months later, 20 percent of participants were considered dependent, scoring a level three or higher.

The study found that stroke survivors with depression were more likely to be dependent if they were older, had other coinciding health problems or were severely depressed compared to those who were younger (64 vs. 59), free of other health problems (18 vs. 15 points on a test for co-morbidities) or not depressed (16 vs. 14 points on a patient health questionnaire).

The study did not determine whether improvement in depression helped people with recovering their independence after three months. "Even if the treatment and improvement of post-stroke depression does not directly influence recovery, it is extremely important for depression to be identified and treated since it is associated with other health and social problems," Schmid said.

The study was supported by the National Institutes of Health and the National Institute of Neurological Disorders and Stroke.

Journal Reference:

1. A.A. Schmid et al. Poststroke depression and treatment effects on functional outcomes. Neurology, March 15, 2011 vol. 76 no. 11 1000-1005 DOI: 10.1212/WNL.0b013e318210435e

— In a major breakthrough in the battle against Parkinson's disease, researchers at the University of Colorado School of Medicine have discovered a drug that stops the progression of the degenerative illness in mice and is now being tested in humans.

"Drugs currently used to treat Parkinson's disease just treat symptoms; they do not stop the disease from getting worse," said senior author Curt Freed, MD, who heads the division of Clinical Pharmacology and Toxicology at the CU School of Medicine. "We've now discovered that we can prevent the progression of the disease by turning on a protective gene in the brain."

The results have been published on line in the Journal of Biological Chemistry.

Lead author Wenbo Zhou, PhD, Assistant Professor of Medicine, and Freed, a national pioneer in Parkinson's research, have found that the drug phenylbutyrate turns on a gene that can protect dopamine neurons in Parkinson's disease. The gene, called DJ-1, can increase production of antioxidants like glutathione to reduce the debilitating effects of excess oxygen in brain cells. In addition, activating DJ-1 helps cells eliminate abnormal proteins that otherwise accumulate and kill brain cells. Dopamine neurons are particularly susceptible to too much oxygen and abnormal protein deposits. Parkinson's disease is caused by dying midbrain dopamine neurons.

Zhou and Freed have studied the DJ-1 gene since 2003 when a European group discovered that mutations in DJ-1 could cause Parkinson's disease. The Colorado scientists immediately started work to see why the gene was so important and have published a series of papers on the subject since 2005. But to convert their findings into a practical treatment for Parkinson's disease, they needed to find a drug to turn on the DJ-1 gene.

"We know some drugs can turn on genes. For example, steroids like testosterone act on genes in muscle cells to create muscle bulk," said Freed.

After testing many drugs, the team found that phenylbutyrate could activate DJ-1 and keep dopamine neurons from dying. Next, they put the drug in the drinking water of mice genetically programmed to get Parkinson's disease as they aged.

Aging mice receiving the drug were able to move normally, had no decline in mental function, and their brains did not accumulate the protein that causes Parkinson's. By contrast, older animals that did not get the drug saw a steady decline in their ability to move as their brains were damaged by abnormal proteins.

The researchers began giving phenylbutyrate to people in 2009, to test the safety of the drug in Parkinson patients.

Zhou and Freed will publish the human results in the coming months.

"We look forward to a future when Parkinson patients will be able to take a pill that will turn on the DJ-1 gene and stop the progressive disability associated with the illness," Freed said. "Right now, when you get the diagnosis of Parkinson's, you can expect to have a steady decline in the ability to move. While drugs like L-DOPA are very important for generating dopamine in the brain and making movement possible, these drugs have little impact on the ongoing deterioration of the patients' own brain cells."

Over one million people in the United State have the disease which usually strikes those in their 50s and 60s. Patients have a decline in their ability to walk, talk, and write because of slow movement and rigid muscles. They develop tremors and reflexes slow down. The current treatment of Parkinson's is based on drugs that increase dopamine production in the brain.

Freed is a national leader in transplanting dopamine cells into the human brain to relieve symptoms. He and his neurosurgical colleague Robert Breeze, MD, have done the operation in 61 patients, more than any other group in the world. The procedure can replace the need for drugs but even cell transplants do not prevent the progression of the disease.

Freed and Zhou are now looking for other drugs that might turn on the DJ-1 gene. One drawback of phenylbutyrate is that patients must take very large doses, 16 grams per day or 32 large tablets taken at frequent intervals. While the drug is approved by the FDA for treating a rare genetic disease in infants, whether it can stop Parkinson's in people remains to be seen.

But Zhou and Freed believe the discovery offers new hope for those suffering from Parkinson's disease.

"If we can say to someone that as of today we can stop your disease from getting worse, that would be a truly significant achievement," Freed said.

Journal Reference:

1. W. Zhou, K. Bercury, J. Cummiskey, N. Luong, J. Lebin, C. R. Freed. Phenylbutyrate upregulates DJ-1 and protects neurons in cell culture and in animal models of Parkinson's disease. Journal of Biological Chemistry, 2011; DOI: 10.1074/jbc.M110.211029